Casey Seiler: DREAM Act for kidneys

CASEY SEILER

Published 3:36 pm, Saturday, October 3, 2015

To hear the invective from the presidential campaign trail, one would think undocumented immigrants are trying to take everything in America that isn't bolted down — jobs, social services, educational benefits, you name it.

Prepare to see kidneys added to the neo-nativist list.

In what might be bluntly described as the DREAM Act for those suffering end-stage renal failure, state Sen. Jose Peralta last week introduced legislation that would require the state to pay for kidney transplants for undocumented immigrants who are otherwise eligible, and have already undergone two years of emergency dialysis in New York.

The Queens Democrat is a major supporter of the non-kidney-transplant version of the DREAM Act, which would make state higher education aid available to the children of undocumented immigrants. That proposal is vehemently opposed by Republicans, who argue that aid is a finite resource that needs to be directed to legal citizens of New York.

Probably because we are the state most identified with the American immigrant experience, New York is more generous than most in providing a safety net for those in this country illegally. Just as the state provides elementary and secondary education to children of non-citizens, it provides health care to resident undocumented immigrants who would otherwise qualify for Medicaid.

Certainly there are people who would like to see illegal immigrants stripped of both benefits, thereby creating an American existence so miserable that they might be more readily induced to hightail it back to their native land, or someone else's nation. Unless, of course, they come from places like Syria or Guatemala, where the prospect of returning to endemic violence might make a slow death as an uninvited guest in the Land of Liberty seem preferable. But would you want them living in your neighborhood as their situation deteriorated? You might have to look at them on the sidewalk.

The court-created status that makes undocumented immigrants eligible for basic health care is known as "PRUCOL," or Permanent Residence Under Color of Law — color of law being a few shades away from actual federal immigration law. With no help from the federal government, New York currently covers emergency dialysis, which costs upwards of $77,000 per year, according to a 2012 article in the American Journal of Kidney Diseases. A kidney transplant and the first year of treatment after surgery costs Medicare, which covers U.S. citizens of any age with end-stage renal disease, around $110,000 on average, though costs can rise depending on the need for anti-rejection drugs.

"Taking a conservative estimate of eight years of life expectancy for the average undocumented immigrant patient, paying for transplant would translate into savings of $321,000 per patient in New York," says the report, which by coincidence looked at Elmhurst Hospital Center in Peralta's district.

Extrapolated for the 27 undocumented patients in Elmhurst's dialysis unit who had potential living donors, the report's authors concluded it would mean a savings of $8 million over eight years. Again, that's one hospital.

"Even if you don't want to take the moral argument, it would save New York tens of millions of dollars," Peralta told me last week.

The law is similar to one passed in Illinois a year ago that's thought to be the first of its kind in the nation. Peralta's bill, unlike the Illinois law, would require the patient to be resident in New York during the two years of emergency dialysis. That undercuts potential criticisms that the bill would encourage some sort of kidney tourism in which someone who received two years of treatment in, say, Ciudad Juarez or Jersey City travels to Long Island or Utica and demands being placed on the organ donor waiting list.

So Peralta seems to have fiscal logic as well as bioethics on his side. Alas, logic rarely wins the day in arguments over immigration policy in New York, or most other states.

In 2007, Gov. Eliot Spitzer had a fairly strong argument for issuing special driver's licenses to undocumented immigrants, a change that would have reduced the number of both unlicensed and uninsured drivers around the state. The strong opposition to his plan — which went through several iterations — was partially due to Spitzer's non-cuddly governing style, but was mainly the result of the visceral response that a large portion of the population has to treating illegal immigrants as functioning members of our society.

Peralta is already prepared for the slippery-slope argument that if you give a critically ill undocumented immigrant a kidney transplant one day, she'll be back tomorrow asking for a new heart or a fresh set of lungs.